House File 617 - Reprinted HOUSE FILE 617 BY COMMITTEE ON WAYS AND MEANS (SUCCESSOR TO HF 581) (SUCCESSOR TO HSB 48) (As Amended and Passed by the House April 10, 2013 ) A BILL FOR An Act relating to the licensure of ambulatory surgical 1 centers, providing for fees to be considered repayment 2 receipts, providing penalties, and including effective date 3 provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 HF 617 (3) 85 pf/nh/md

H.F. 617 Section 1. NEW SECTION . 135P.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Ambulatory surgical center” means a distinct facility 4 that operates exclusively for the purpose of providing surgical 5 services to patients not requiring hospitalization and in which 6 the expected duration of services does not exceed twenty-four 7 hours following admission. “ Ambulatory surgical center” 8 includes a facility certified or seeking certification as an 9 ambulatory surgical center under the federal Medicare program 10 or under the medical assistance program established pursuant 11 to chapter 249A. “Ambulatory surgical center” does not include 12 the individual or group practice office of a private physician, 13 podiatrist, or dentist who there engages in the lawful practice 14 of surgery, or the portion of a licensed hospital designated 15 for outpatient surgical treatment. 16 2. “Department” means the department of inspections and 17 appeals. 18 Sec. 2. NEW SECTION . 135P.2 Purpose. 19 The purpose of this chapter is to protect the public 20 health, safety, and welfare by providing for the licensing and 21 regulation of ambulatory surgical centers. 22 Sec. 3. NEW SECTION . 135P.3 Licensure. 23 A person, acting severally or jointly with any other person, 24 shall not establish, operate, or maintain an ambulatory 25 surgical center in this state without obtaining a license as 26 provided under this chapter. 27 Sec. 4. NEW SECTION . 135P.4 Application for license —— fee. 28 1. An applicant for an ambulatory surgical center license 29 shall submit an application to the department. Applications 30 shall be upon such forms and shall include such information 31 as the department may reasonably require, which may include 32 affirmative evidence of ability to comply with reasonable rules 33 and standards prescribed under this chapter. 34 2. An application for an initial license for an ambulatory 35 -1- HF 617 (3) 85 pf/nh/md 1/ 11

H.F. 617 surgical center shall be accompanied by a fee of fifty dollars. 1 3. The fees collected under this section shall be considered 2 repayment receipts as defined in section 8.2 and shall be used 3 by the department to administer this chapter. 4 Sec. 5. NEW SECTION . 135P.5 Issuance and renewal of 5 license. 6 1. Upon receipt of an application for license and the 7 license fee, the department shall issue a license if the 8 applicant and the ambulatory surgical center meet the 9 requirements of this chapter and the rules adopted by the 10 department. 11 2. A license shall be issued only for the premises and 12 persons named in the application. 13 3. A license is not transferable or assignable except with 14 the written approval of the department. 15 4. A license shall be posted in a conspicuous place on the 16 licensed premises as prescribed by rule of the department. 17 5. Separate licenses are not required for ambulatory 18 surgical center facilities that are maintained on the same 19 physical site and that have the same ownership or control. 20 Multiple buildings located on the same physical site under the 21 same ownership or control shall be considered one ambulatory 22 surgical center facility for purposes of this chapter and 23 section 135.61, subsection 21, and may operate under one 24 license. 25 6. A license, unless sooner suspended or revoked, shall 26 expire on June 30 of each year and shall be renewed annually. 27 The department shall renew a license upon payment of a five 28 hundred dollar annual license renewal fee and filing of an 29 application for renewal at least thirty days prior to the 30 expiration of the existing license. The annual licensure fee 31 shall be considered a repayment receipt as defined in section 32 8.2 and dedicated to support the staffing necessary to conduct 33 the inspections and investigations provided in section 135P.8. 34 Sec. 6. NEW SECTION . 135P.6 Denial, suspension, or 35 -2- HF 617 (3) 85 pf/nh/md 2/ 11

H.F. 617 revocation of license —— hearings and review. 1 1. The department may deny, suspend, or revoke a license in 2 any case where it finds there has been a substantial failure 3 to comply with this chapter or the rules and standards adopted 4 under this chapter. 5 2. The denial, suspension, or revocation of a license by 6 the department and appeal from that action are governed by the 7 procedures for a contested case hearing under chapter 17A. 8 3. a. If the department finds, after providing notice of 9 noncompliance and a reasonable time for corrective action, that 10 an ambulatory surgical center is in repeated noncompliance with 11 this chapter or the department’s rules but that noncompliance 12 does not endanger public health or safety, the department may 13 issue a conditional license to the ambulatory surgical center 14 as an alternative to suspending or revoking the ambulatory 15 surgical center’s license. 16 b. The department shall provide notice of its intent to 17 issue a conditional license to the ambulatory surgical center 18 and of the items of noncompliance not less than ten days before 19 the date the conditional license is issued. 20 c. The department shall designate a period of not more 21 than one year during which the ambulatory surgical center may 22 operate under a conditional license. 23 d. During the period an ambulatory surgical center is 24 operating under a conditional license, the ambulatory surgical 25 center shall correct the items that are in noncompliance and 26 report the corrections to the department for approval. 27 4. The department may suspend or revoke the license of an 28 ambulatory surgical center that does not correct items that 29 are in noncompliance or that does not comply with this chapter 30 or the rules adopted under this chapter within the applicable 31 period. 32 5. The department may issue an emergency order to suspend 33 a license issued under this chapter if the department has 34 reasonable cause to believe that the conduct of the ambulatory 35 -3- HF 617 (3) 85 pf/nh/md 3/ 11

H.F. 617 surgical center creates an immediate danger to the public 1 health and safety. An emergency suspension is effective 2 immediately without a hearing or notice to the licensee. On 3 written request of the licensee, the department shall conduct 4 a hearing not earlier than the tenth day or later than the 5 thirtieth day after the date the hearing request is received 6 to determine if the emergency suspension is to be continued, 7 modified, or rescinded. The hearing and any appeal are 8 governed by the department’s rules for a contested case hearing 9 and chapter 17A. 10 Sec. 7. NEW SECTION . 135P.7 Rules. 11 1. The department, with the advice and approval of the state 12 board of health, shall adopt rules specifying the standards for 13 ambulatory surgical centers to be licensed under this chapter. 14 The rules shall be consistent with and shall not exceed the 15 requirements of this chapter and the conditions for coverage in 16 the federal Medicare program for ambulatory surgical centers 17 under 42 C.F.R. pt. 416. 18 2. The department shall adopt rules as the department deems 19 necessary to implement the provisions of this chapter relating 20 to the issuance, renewal, denial, suspension, and revocation 21 of a license to establish, operate, and maintain an ambulatory 22 surgical center. 23 3. An ambulatory surgical center which is in operation at 24 the time of adoption of any applicable rules or standards under 25 this chapter shall be given a reasonable time, not to exceed 26 one year from the date of adoption, within which to comply with 27 such rules and standards. 28 4. The department shall enforce the rules. 29 Sec. 8. NEW SECTION . 135P.8 Inspections. 30 1. The department shall make or cause to be made inspections 31 or investigations of ambulatory surgical centers to determine 32 compliance with this chapter and applicable rules and 33 standards. The department shall perform inspections on a 34 schedule that is of the same frequency required for inspections 35 -4- HF 617 (3) 85 pf/nh/md 4/ 11

H.F. 617 of Medicare-certified ambulatory surgical centers. 1 2. The department shall recognize, in lieu of its own 2 licensure inspection, the comparable inspection and inspection 3 findings of a Medicare conditions for coverage survey completed 4 by the department or an accrediting organization authorized by 5 the centers for Medicare and Medicaid services with deeming 6 authority. 7 3. A department inspector shall not participate in an 8 inspection or investigation of an ambulatory surgical center in 9 which the inspector or a member of the inspector’s immediate 10 family works or has worked within the last two years or in 11 which the inspector or the inspector’s immediate family has 12 a financial ownership interest. For the purposes of this 13 section, “immediate family member” means a spouse, natural or 14 adoptive parent or grandparent, child, grandchild, sibling, 15 stepparent, stepchild, or stepsibling. 16 Sec. 9. NEW SECTION . 135P.9 Employee background checks. 17 1. a. Prior to employment of a person in an ambulatory 18 surgical center, the ambulatory surgical center shall request 19 that the department of public safety perform a criminal 20 history check and the department of human services perform 21 child and dependent adult abuse record checks of the person 22 in this state. An ambulatory surgical center shall inform 23 all persons prior to employment regarding the performance of 24 the record checks and shall obtain from the persons a signed 25 acknowledgment of the receipt of the information. 26 b. An ambulatory surgical center shall include the following 27 inquiry in an application for employment: 28 Do you have a record of founded child or dependent adult abuse 29 or have you ever been convicted of a crime, in this state or any 30 other state? 31 2. a. If it is determined that a person being considered 32 for employment in an ambulatory surgical center has been 33 convicted of a crime, the department of public safety shall 34 notify the ambulatory surgical center that upon the request 35 -5- HF 617 (3) 85 pf/nh/md 5/ 11

H.F. 617 of the ambulatory surgical center the department of human 1 services will perform an evaluation to determine whether the 2 crime warrants prohibition of the person’s employment in the 3 ambulatory surgical center. 4 b. If a department of human services child or dependent 5 adult abuse record check shows that the person has a record of 6 founded child or dependent adult abuse, the department of human 7 services shall notify the ambulatory surgical center that upon 8 the request of the ambulatory surgical center the department of 9 human services will perform an evaluation to determine whether 10 the founded child or dependent adult abuse warrants prohibition 11 of the person’s employment in the ambulatory surgical center. 12 c. An evaluation performed under this subsection shall 13 be performed in accordance with procedures adopted for this 14 purpose by the department of human services. 15 d. (1) If a person owns or operates more than one 16 ambulatory surgical center, and an employee of one of such 17 ambulatory surgical centers is transferred to another such 18 ambulatory surgical center without a lapse in employment, 19 the ambulatory surgical center is not required to request 20 additional criminal and child and dependent adult abuse record 21 checks of that employee. 22 (2) If the ownership of an ambulatory surgical center is 23 transferred, at the time of transfer the record checks required 24 by this section shall be performed for each employee for whom 25 there is no documentation that such record checks have been 26 performed. The ambulatory surgical center may continue to 27 employ such employee pending the performance of the record 28 checks and any related evaluation. 29 3. In an evaluation, the department of human services 30 shall consider the nature and seriousness of the crime 31 or founded child or dependent adult abuse in relation to 32 the position sought or held, the time elapsed since the 33 commission of the crime or founded child or dependent adult 34 abuse, the circumstances under which the crime or founded 35 -6- HF 617 (3) 85 pf/nh/md 6/ 11

H.F. 617 child or dependent adult abuse was committed, the degree of 1 rehabilitation, the likelihood that the person will commit 2 the crime or founded child or dependent adult abuse again, 3 and the number of crimes or founded child or dependent adult 4 abuses committed by the person involved. If the department of 5 human services performs an evaluation for the purposes of this 6 section, the department of human services has final authority 7 in determining whether prohibition of the person’s employment 8 is warranted. 9 4. a. Except as provided in paragraph “b” and subsection 2, 10 a person who has been convicted of a crime or has a record of 11 founded child or dependent adult abuse shall not be employed 12 in an ambulatory surgical center licensed under this chapter 13 unless an evaluation has been performed by the department of 14 human services. 15 b. A person with a criminal or abuse record who is or was 16 employed by an ambulatory surgical center licensed under this 17 chapter and is hired by an employer who is another licensee 18 without a lapse in employment shall be subject to the criminal 19 history and abuse record checks required pursuant to subsection 20 1. However, if an evaluation was previously performed by the 21 department of human services concerning the person’s criminal 22 or abuse record and it was determined that the record did not 23 warrant prohibition of the person’s employment and the latest 24 record checks do not indicate a crime was committed or founded 25 abuse record was entered subsequent to that evaluation, the 26 person may commence employment with the other licensee in 27 accordance with the department of human services’ evaluation 28 and an exemption from the requirements in paragraph “a” for 29 reevaluation of the latest record checks is authorized. 30 Otherwise, the requirements of paragraph “a” remain applicable 31 to the person’s employment. Authorization of an exemption 32 under this lettered paragraph “b” from requirements for 33 reevaluation of the latest record checks by the department of 34 human services is subject to all of the following provisions: 35 -7- HF 617 (3) 85 pf/nh/md 7/ 11

H.F. 617 (1) The position with the subsequent employer is 1 substantially the same or has the same job responsibilities as 2 the position for which the previous evaluation was performed. 3 (2) Any restrictions placed on the person’s employment in 4 the previous evaluation by the department of human services 5 shall remain applicable in the person’s subsequent employment. 6 (3) The person subject to the record checks has maintained a 7 copy of the previous evaluation and provides the evaluation to 8 the subsequent employer or the previous licensee provides the 9 previous evaluation from the person’s personnel file pursuant 10 to the person’s authorization. If a physical copy of the 11 previous evaluation is not provided to the subsequent employer 12 the record checks shall be reevaluated. 13 (4) Although an exemption under this lettered paragraph “b” 14 may be authorized, the subsequent employer may instead request 15 a reevaluation of the record checks and may employ the person 16 while the reevaluation is being performed. 17 5. a. If a person employed by an ambulatory surgical center 18 licensed under this chapter is convicted of a crime or has a 19 record of founded child or dependent adult abuse entered in the 20 abuse registry after the person’s employment application date, 21 the person shall inform the ambulatory surgical center of such 22 information within forty-eight hours of the criminal conviction 23 or entry of the record of founded child or dependent adult 24 abuse. The ambulatory surgical center shall act to verify 25 the information within forty-eight hours of notification. If 26 the information is verified, the requirements of subsections 27 2, 3, and 4 regarding employability and evaluations shall 28 be applied by the ambulatory surgical center to determine 29 whether or not the person’s employment is continued. The 30 ambulatory surgical center may continue to employ the person 31 pending the performance of an evaluation by the department 32 of human services to determine whether prohibition of the 33 person’s employment is warranted. A person who is required by 34 this subsection to inform the ambulatory surgical center of 35 -8- HF 617 (3) 85 pf/nh/md 8/ 11

H.F. 617 a conviction or entry of an abuse record and fails to do so 1 within the required period commits a serious misdemeanor. 2 b. If an ambulatory surgical center receives credible 3 information, as determined by the ambulatory surgical center, 4 that a person employed by the ambulatory surgical center has 5 been convicted of a crime or a record of founded child or 6 dependent adult abuse has been entered in the abuse registry 7 after employment from a person other than the employee and the 8 employee has not informed the ambulatory surgical center of 9 such information within the period required under paragraph 10 “a” , the ambulatory surgical center shall act to verify the 11 credible information within forty-eight hours of receipt of 12 the credible information. If the information is verified, the 13 requirements of subsections 2, 3, and 4 regarding employability 14 and evaluations shall be applied by the ambulatory surgical 15 center to determine whether or not the person’s employment is 16 continued. 17 c. The ambulatory surgical center may notify the county 18 attorney for the county where the ambulatory surgical center is 19 located of any violation or failure by an employee to notify 20 the ambulatory surgical center of a criminal conviction or 21 entry of an abuse record within the period required under 22 paragraph “a” . 23 6. An ambulatory surgical center licensed under this 24 chapter may access the single contact repository established by 25 the department pursuant to section 135C.33 as necessary for the 26 ambulatory surgical center to perform record checks of persons 27 employed or being considered for employment by the ambulatory 28 surgical center. 29 Sec. 10. NEW SECTION . 135P.10 Confidentiality. 30 The department’s final findings with respect to compliance 31 by an ambulatory surgical center with requirements for 32 licensing shall be made available to the public in a readily 33 available form and place. Other information relating to 34 an ambulatory surgical center obtained by the department 35 -9- HF 617 (3) 85 pf/nh/md 9/ 11

H.F. 617 which does not constitute the department’s findings from an 1 inspection of the ambulatory surgical center shall not be made 2 available to the public, except in proceedings involving the 3 denial, suspension, or revocation of a license under this 4 chapter. The name of a person who files a complaint with the 5 department shall remain confidential and shall not be subject 6 to discovery, subpoena, or other means of legal compulsion for 7 its release to a person other than department employees or 8 agents involved in the investigation of the complaint. 9 Sec. 11. NEW SECTION . 135P.11 Injunction. 10 Notwithstanding the existence or pursuit of any other 11 remedy, the department may, in the manner provided by law, 12 maintain an action in the name of the state for injunction 13 or other process against any person to restrain or prevent 14 the establishment, operation, or maintenance of an ambulatory 15 surgical center without a license. 16 Sec. 12. NEW SECTION . 135P.12 Judicial review. 17 Judicial review of an action of the department may be sought 18 in accordance with chapter 17A. Notwithstanding the provisions 19 of chapter 17A, petitions for judicial review may be filed 20 in the district court of the county in which the ambulatory 21 surgical center is located or is to be located and the status 22 quo of the petitioner or licensee shall be preserved pending 23 final disposition of the judicial review matter. 24 Sec. 13. NEW SECTION . 135P.13 Penalties. 25 Any person establishing, operating, or maintaining any 26 ambulatory surgical center without a license commits a serious 27 misdemeanor, and each day of continuing violation after 28 conviction shall be considered a separate offense. 29 Sec. 14. Section 135.11, Code 2013, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 32. Adopt rules requiring ambulatory 32 surgical centers to report quality data to the department of 33 public health that is consistent with the data required to be 34 reported to the centers for Medicare and Medicaid services 35 -10- HF 617 (3) 85 pf/nh/md 10/ 11

H.F. 617 of the United States department of health and human services 1 as authorized by the Medicare Improvements and Extension Act 2 of 2006 under Title I of the Tax Relief and Health Care Act 3 of 2006, Pub. L. No. 109-432, and the regulations adopted 4 under such Acts. Notwithstanding any provision of law to 5 the contrary, nothing in this subsection shall require an 6 ambulatory surgical center to provide health data to the 7 department of public health or any other public or private 8 entity that is in addition to, different than, or exceeds 9 the quality data required to be reported to the centers for 10 Medicare and Medicaid services of the United States department 11 of health and human services. 12 Sec. 15. Section 135.61, Code 2013, is amended by adding the 13 following new subsection: 14 NEW SUBSECTION . 1A. “Ambulatory surgical center” means 15 ambulatory surgical center as defined in section 135P.1. 16 Sec. 16. Section 135.61, subsection 14, paragraph d, Code 17 2013, is amended to read as follows: 18 d. An outpatient ambulatory surgical facility center . 19 Sec. 17. Section 135.61, subsection 21, Code 2013, is 20 amended by striking the subsection. 21 Sec. 18. EFFECTIVE DATE. This Act takes effect July 1, 22 2014. 23 -11- HF 617 (3) 85 pf/nh/md 11/ 11